Color Us Frustrated

— A new EHR brings many annoyances to Fred N. Pelzman, MD, and colleagues

So we rolled out a new version of our electronic health record (EHR) over this past weekend.

They have been warning us that it was coming for weeks and weeks, endless emails as well as system messages within the electronic health record, informing us that on Friday night, the system would be down for a major overhaul, a planned upgrade to version 2015.

Just in time for 2016.

When Monday morning arrived, and we logged on, the most shocking thing was the change in the color palette. All I heard about all morning long (for that matter, most of this week), has been how annoying and visually difficult the colors are on the new version. For some reason they selected a default palette that makes it really hard to read the tiny font, expand windows, and find the tabs and other buttons we need to click on.

Now, that's really just an aesthetic thing, and ultimately people realized that there was a way to click and find a customization menu that allows you to change to the color palette to one of your choosing. They include such exciting color combinations as "Horsepower," "Cool Mint," "Kyoto," "Sunrise," and "Doris Daisy." I can only assume these are trademarked and were developed after focus groups with design specialists with expertise in calming enraged healthcare providers.

Once we got over this trauma, the real fun began.

Where is BMI? How come I can't find a BMI? Did they stop calculating BMI for our patients?

Calm down; they moved it -- it's right over there.

Why are my comments from my lab review showing up on the printed version of the labs, I don't think I wanted patients to see what I wrote about their labs, do they have to see those?

What are those tiny little icons in the media section, how am I ever going to find that scanned copy of a colonoscopy from years ago if it takes 10 minutes to load each TIF image that just tells me what it is?

The annoying pop-up balloons every time you hover over something, new little tricks and tips and advice for them to teach us about highlighting our favorite tabs to make them easier to pick out from the bland monotonous background. Why didn't they just highlight them in the first place? You think?

The biggest problem, unfortunately, was a bug they discovered only after they rolled this version out.

None of the sections where we type into the visit navigator, where we build our progress note, were being saved to the EHR.

So we could blithely go along creating our documentation of the office visit, typing in chief complaint, HPI, past medical history, past surgical history, social history, family history, allergies, medications, review of systems, physical exam, assessment and plan, and finally get to the end, and realize that nothing had been saved by the system.

Lots of providers with steam coming out of their ears.

It turns out that in transferring our visit navigator module from the old version to the new, something had been left out, and therefore a different mechanism for saving these individual components was now necessary, and it took most of the day before they were able to repair this. A lot of work got lost and a lot of confusion ensued.

By midday on Monday morning, our clinical leader who serves as the liaison with the EHR team looked like he was about to have a stroke, or at least pass out.

Despite his frustrations, we recognize that they did this in an effort to improve the software, to move on to a newer better version, that usually upgrades are meant to make our lives easier.

Unfortunately, what we see is more and more functionality, more bells and whistles, but less and less ability for us to really truly create a meaningful electronic record of our interactions with our patients.

There are more and more boxes to click, more and more work that you need to do to get through a visit, and it feels like there's less and less actual quality clinical content, less of the heart of the matter, less of what we need to communicate, that ends up being put down in the chart.

As we continue to refine these electronic systems that were designed, theoretically, to help us take care of patients, we need to reinvigorate our efforts as clinicians to get back into the mix of guiding this process, transforming it into a real documentation and communication tool, whose main purpose is to help providers care for patients as they move from one place in the system to another.

We all recognize that there need to be these boxes to click, that collecting and standardizing data can be useful for research, patient safety, and quality improvement.

But it is clear that we need to change from Calming Baby Blue to Shocking Fire Alarm Red, to wake us up and get us moving, onto a path towards a revolution in what the electronic health record can, should, and must be.

If not, we are doomed to waiting for version 2017 to lull us deeper into complacency, and away from truly great clinical care.

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